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Explaining the dimensions of social support for breakfast and healthy snacks in students: a qualitative study

Fatemeh Bastami , Arash Ardalan , Fereshteh Zamani-Alavijeh and Firoozeh Mostafavi EMAIL logo



breakfast elimination as well as consumption of low-value snacks is ever increasing among adolescents. This study sought to explain the dimensions of social support for breakfast and healthy snacks among students.


A qualitative research was conducted in Isfahan, Tehran, and Khorramabad, Iran high schools in 2017–18. Data were obtained from five focus group discussions and 35 in-depth interviews as well as semi-structured interviews with students of both sex, parents and school authorities. The data simultaneously analyzed using conventional content analysis in three stages including preparation, organization, and reporting. Prolonged engagement, maximum variation of sampling and member check were the enrichment factors of the research.


Three main categories emerged. First, family supports with sub- categories of family in the school programs as well as mother-sponsored support and family life patterns. Second, school supports with sub- categories of instrumental and informational support. And third, support of other community organizations with sub- categories of intra-department coordination and mass media.


The concepts emerging in the present study develop multilevel ecological strategies to promote nutritional health including family, school, and community organizations such as school renovations, municipalities, police, education, and mass media to promote healthy breakfast and snack behavior are applicable for students.

Corresponding author: Firoozeh Mostafavi, Associate Professor, Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran, E-mail:

Award Identifier / Grant number: 396420


The researchers would also like to express their gratitude to Dr. Marzieh Araban Faculty member of the Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran and Iraj Zareban Faculty member of the Zahedan University of Medical Sciences, Zahedan, Iran for thier cooperation in the editing of the article.

  1. Research funding: This study was funded by the Isfahan University of Medical Sciences as part of a doctoral thesis with the registration number 396420.

  2. Authors’ contributions: FM and FB have made substantial contributions to conception and design, writing and revising the manuscript. FZ-A and AA were involved in drafting the manuscript and revising it critically for important intellectual content.

  3. Competing interests: All authors have read and approved the content of the article. The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

  4. Ethics approval and consent to participate: Informed consent was obtained from the parents. Consent to participate was verbal. The parents consented to the recording of the voices of the students during interviews. The Ethics Committee of Isfahan University of Medical Sciences approved the study protocol with the approval number IR.MUI.REC. 1396.3.420.


1. Gibney, MJ, Barr, SI, Bellisle, F, Drewnowski, A, Fagt, S, Livingstone, B, et al. Breakfast in human nutrition: the international breakfast research initiative. Nutrients 2018;10. in Google Scholar

2. Soheili Azad, A, Nourjah, N, Norouzi, F. Survey the eating pattern between elementary students in Langrood. J Guilan Uni Med Sci 2007;16:36–41.Search in Google Scholar

3. Veghari, G, Mansourian, AR. Breakfast consumption amongst school children in northern Iran. J Nepal Paediatric Soc 2012;32:193–200.10.3126/jnps.v32i3.6095Search in Google Scholar

4. Kann, L, Eaton, DK, Kinchen, S, Shanklin, S, Ross, J, Hawkins, J, et al. Youth risk behavior surveillance - United States, 2017. MMWR Surveill Summ 2018;67:1–114. in Google Scholar

5. Aldubayan, K, Murimi, M. Compliance with school nutrition policy in Saudi Arabia: a quantitative study. Eastern Mediterranean Health Journal 2019;25:230–8. in Google Scholar

6. Kelishadi, R, Mozafarian, N, Qorbani, M, Motlagh, ME, Safiri, S, Ardalan, G, et al. Is snack consumption associated with meal skipping in children and adolescents? The CASPIAN-IV study. Eat Weight Disord 2017;22:321–8. in Google Scholar

7. Sedibe, HM, Kahn, K, Edin, K, Gitau, T, Ivarsson, A, Shane, AN, et al. Qualitative study exploring healthy eating practices and physical activity among adolescent girls in rural South Africa. BMC Pediatrics 2014;14:211. in Google Scholar

8. Bastami, F, Zamani-Alavijeh, F, Mostafavi, F, Almasian, M, Hydari, M. Formative research on a social marketing campaign to promote the consumption of healthy breakfast and snacks: a qualitative study. Int J Pediatrics 2018;6:7353–67.Search in Google Scholar

9. Sutter, C, Nishina, A, Scherr, RE, Zidenberg-Cherr, S, Ontai, LL. Sharing, trading, stealing: Exploring the role of peers in shaping foods available at lunchtime. J Early Adolescence 2016;36:449–64. in Google Scholar

10. Levin, KA, Kirby, J. Irregular breakfast consumption in adolescence and the family environment: underlying causes by family structure. Appetite 2012;59:63–70. in Google Scholar

11. Ashe, KM, Lapane, KL. Food Insecurity and Obesity: Exploring the Role of Social Support. J Womens Health (Larchmt) 2018;27:651–8. in Google Scholar

12. Chhabra, S, Falciglia, GA, Lee, SY. Social capital, social support, and food insecurity in food pantry users. Ecol Food Nutr, 2014;53:678–92. in Google Scholar

13. Utter, J, Scragg, R, Schaaf, D, Mhurchu, CN. Relationships between frequency of family meals, BMI and nutritional aspects of the home food environment among New Zealand adolescents. Int J Behav Nutr Phys Act 2008;5:50. in Google Scholar

14. Martens, MK, van Assema, P, Brug, J. Why do adolescents eat what they eat? Personal and social environmental predictors of fruit, snack and breakfast consumption among 12-14-year-old Dutch students. Public Health Nutr 2005;8:1258–65. in Google Scholar

15. Wen, X, Hui, SS-C. Parenting style as a moderator of the association between parenting behaviors and the weight status of adolescents. The Journal of Early Adolescence 2012;32:252–68. in Google Scholar

16. Fitzpatrick, KM, Willis, D, O’Connor, G. Circumstances, resources, and weight status outcomes among middle school students. The Journal of Early Adolescence 2014;34:1058–74. in Google Scholar

17. Bruening, M, Larson, N, Story, M, Neumark-Sztainer, D, Hannan, P, MStat. Predictors of adolescent breakfast consumption: longitudinal findings from Project EAT. J Nutr Educ Behav 2011;43:390–5. in Google Scholar

18. van Manen, M. Phenomenology in Its Original Sense. Qual Health Res 2017;27:810–25. in Google Scholar

19. Speziale, HS, Streubert, HJ, Carpenter, DR, Qualitative research in nursing: Advancing the humanistic imperative. 2011: Lippincott Williams & Wilkins.Search in Google Scholar

20. Hsieh, H-F, Shannon, SE. Three approaches to qualitative content analysis. Qualitative health research 2005;15:1277–88. in Google Scholar

21. Elo, S, Kyngas, H. The qualitative content analysis process. J Adv Nurs 2008;62:107–15. in Google Scholar

22. Siega-Riz, AM, Popkin, BM, Carson, T. Trends in breakfast consumption for children in the United States from 1965-1991. Am J Clin Nutr 1998;67:748s–56s. in Google Scholar

23. Patrick, H, Nicklas, TA. A review of family and social determinants of children’s eating patterns and diet quality. J Am Coll Nutr 2005;24:83–92. in Google Scholar

24. Gebremariam, MK, Henjum, S, Hurum, E, Utne, J, Terragni, L, Torheim, LE. Mediators of the association between parental education and breakfast consumption among adolescents: the ESSENS study. BMC Pediatrics 2017;17:61. in Google Scholar

25. Lytle, LA, Seifert, S, Greenstein, J, McGovern, P. How do children’s eating patterns and food choices change over time? Results from a cohort study. Am J Health Promot 2000;14:222–8. in Google Scholar

26. Mumm, J, Hearst, MO, Shanafelt, A, Wang, Q, Leduc, R, Nanney, MS. Increasing social support for breakfast: project breakfast. Health Promot Pract 2017;1524839917711123.10.1177/1524839917711123Search in Google Scholar

27. Mullan, B, Wong, C, Kothe, E, O’Moore, K, Pickles, K, Sainsbury, K. An examination of the demographic predictors of adolescent breakfast consumption, content, and context. BMC Public Health 2014;14:264. in Google Scholar

28. van der Horst, K, Oenema, A, Ferreira, I, Wendel-Vos, W, Giskes, K, van Lenthe, F, et al. A systematic review of environmental correlates of obesity-related dietary behaviors in youth. Health Educ Res 2007;22:203–26. in Google Scholar

29. Pearson, N, Biddle, SJ, Gorely, T. Family correlates of fruit and vegetable consumption in children and adolescents: a systematic review. Public Health Nutr 2009;12:267–83. in Google Scholar

30. Granner, ML, Sargent, RG, Calderon, KS, Hussey, JR, Evans, AE, Watkins, KW. Factors of fruit and vegetable intake by race, gender, and age among young adolescents. J Nutr Educ Behav 2004;36:173–80. in Google Scholar

31. Pearson, N, Atkin, AJ, Biddle, SJH, Gorely, T, Edwardson, C. Parenting styles, family structure and adolescent dietary behaviour. Public Health Nutr 2010;13:1245–53. in Google Scholar

32. Larson, N, Wang, Q, Berge, JM, Shanafelt, A, Nanney, MS. Eating breakfast together as a family: mealtime experiences and associations with dietary intake among adolescents in rural Minnesota, USA. Public Health Nutr 2016;19:1565–74. in Google Scholar

33. Gosliner, W. School-level factors associated with increased fruit and vegetable consumption among students in California middle and high schools. J Sch Health 2014;84:559–68. in Google Scholar

34. Foley, BC, Shrewsbury, VA, Hardy, LL, Flood, VM, Byth, K, Shah, S. Evaluation of a peer education program on student leaders’ energy balance-related behaviors. BMC Public Health 2017;17:695. in Google Scholar

35. Cleobury, L, Tapper, K. Reasons for eating ‘unhealthy’ snacks in overweight and obese males and females. J Hum Nutr Diet 2014;27:333–41. in Google Scholar

36. Lioutas, ED, Tzimitra-Kalogianni, I. ‘I saw Santa drinking soda!’ Advertising and children’s food preferences. Child Care Health Dev 2015;41:424–33. in Google Scholar

Received: 2019-11-29
Accepted: 2020-01-14
Published Online: 2020-11-02

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